Of all of the options being discussed, Gov. Herbert’s plan is the most thoughtful and common-sense. It serves needy people, brings our tax dollars home, is fiscally responsible, and doesn’t tie us to long-term obligations. (Jeffrey D. Allred, Deseret News)

One of the most important questions facing Utah policymakers is whether to expand Medicaid healthcare coverage for a certain segment of low-income Utahns.

This issue has serious ramifications for people who could be financially devastated by a major illness or accident. It also has consequences for Utah’s economy, which will annually lose hundreds of millions of dollars already paid in federal taxes if this matter isn’t properly resolved.

The people impacted by this issue are mostly working individuals who make less than $11,670 a year, or less than $23,850 for a family of four. They earn too much to qualify for traditional Medicaid, but too little to qualify for health insurance subsidies under the Affordable Care Act (ACA).

These Utahns are caught in a gap without means to obtain health insurance.

Under the original ACA, states were required to expand Medicaid to cover those in this gap. But the U.S. Supreme Court ruled that states could choose to expand or not. Many states did expand, but others, including Utah, did not -- for good reasons. Some states are developing other plans to cover those in the gap.

I believe the Affordable Care Act is a flawed law that needs major revisions or replacement. However, it is currently the law of the land and until it can be revised, we need to make it work as well as possible for the maximum number of Utahns.

It would also be a mistake to forego $258 million a year in tax dollars that Utahns are paying into the federal system. We should bring those tax dollars back to Utah to serve Utah citizens and build Utah’s economy.

Gov. Gary Herbert and his Department of Health have been working on this issue for nearly two years, monitoring other state initiatives, analyzing options and discussing waivers with federal officials. State-based plans require federal waivers to receive funding.

I believe Gov. Herbert has developed, after much hard work, a common-sense solution that should be implemented.

The governor’s plan is much different than simply expanding Medicaid under the ACA. The plan follows four important principles: (1) Ensure individual responsibility by requiring participant cost-sharing and work requirements. (2) Support the private sector by using private insurance companies to provide health insurance (very few people would be added to Medicaid rolls). (3) Maximize state flexibility by creating a three-year trial period, after which the program could be revised or repealed. (4) Respect Utah taxpayers by bringing home tax dollars they’ve paid to the federal government for these purposes.

The program would allow the state to receive Medicaid expansion funds (some $258 million a year) as a block grant, which then would be used to help families purchase health insurance from private insurance companies. A variety of plans would be available to select from, and those who receive insurance premium subsidies would be required to work or receive job training, and make co-pays. The three-year trial period would allow the state to monitor the costs and effectiveness of the program, and ensure that costs don’t exceed projections. The state would not be locked into a long-term expensive Medicaid program.

Some 111,000 Utahns could be covered, and the $258 million per year would be a healthy boost to Utah’s economy.

Of all of the options being discussed, Gov. Herbert’s plan is the most thoughtful and common-sense. It serves needy people, brings our tax dollars home, is fiscally responsible and doesn’t tie us to long-term obligations. I hope the Legislature will work with the governor to win federal waivers and implement this plan.